Physician Utilization Review Expert

Alpheva; United States; Hybrid; USD 138,000 - 248,000; Full time

Job summary

Alpheva seeks a physician reviewer for remote, project-based work to evaluate AI-generated clinical determinations for accuracy and professional judgment. The role emphasizes identifying missing documentation, unsafe assumptions, and escalation needs, while documenting corrections with clear physician reasoning.

Requirements include MD/DO with active US licensure, board certification, and 7+ years post-residency clinical experience; utilization review or case-management background is preferred.

Qualifications

• MD or DO with active US medical licensure.
• Board certification and 7+ years of post-residency clinical experience.
• Utilization review/physician-advisor or hospital case-management experience preferred.

Responsibilities

• Evaluate advanced domain tasks and AI-generated responses for factual accuracy and professional judgment.
• Apply current standards, methods, and risk considerations from healthcare and life sciences.
• Document errors, edge cases, and the reasoning behind an ideal response.
• Collaborate asynchronously with Alpheva's research and evaluation teams.

Skills

Medical-necessity evaluation

Physician-advisor reasoning

Education

MD/DO degree

Board certification

Tools

Utilization review

Case-management experience

Job description

Review medical-necessity, level-of-care, utilization-management, and physician-advisor reasoning using de-identified clinical cases.

Evaluate whether AI-generated determinations accurately connect clinical facts, treatment intensity, expected course, and applicable review criteria.

Identify missing documentation, unsafe assumptions, inappropriate status recommendations, and cases that require peer-to-peer or specialist escalation.

Explain corrections using clear physician reasoning while preserving uncertainty and avoiding unsupported clinical conclusions.

Remote, project-based contract work. Scope and hours depend on project matching; the listed hourly range applies to matched work.

Responsibilities

• Evaluate advanced domain tasks and AI-generated responses for factual accuracy and professional judgment.
• Apply current standards, methods, and risk considerations from healthcare & life sciences.
• Document errors, edge cases, and the reasoning behind an ideal response.
• Collaborate asynchronously with Alpheva's research and evaluation teams.

Required Qualifications

• MD or DO with active or recently active US medical licensure
• Board certification and 7+ years of post-residency clinical experience
• Utilization review, physician-advisor, payer, or hospital case-management experience preferred